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Monitoring System Certification <br /> Site Address 16470 CAMBRIDGE Date of Testing/Service: 10/14/2011 <br /> Q LOUISE <br /> D. Results of Testing/Servicing <br /> Software Version Installed: 14.04 <br /> Complete the following checklist: <br /> X Yes 11 No• Is the audible alarm operational? <br /> ❑X Yes ❑No' Is the visual alarm operational? <br /> Q Yes No' Were all sensors visually inspected,functionally tested,and confirmed operational? <br /> ❑X Yes ❑No Were all sensors installed at lowest point of secondary containment and positioned so that other equipment will not <br /> interfere with their proper operation? <br /> Yes No' X NIA If alarms are relayed to a remote monitoring station, is all communications equipment(e.g.modem)operational? <br /> For pressurized piping systems,does the turbine automatically shut down if the piping secondary containment <br /> ❑X Yes ❑No• ❑NIA monitoring system detects a leak,fails to operate,or is electrically disconnected?If yes:which sensors initiate positive <br /> shut-down?(check all that appy) ❑X Sumplfrench Sensors; ❑ Dispenser Containment Sensors. <br /> Did you confirm positive shut-down due to leaks add sensor failure/disconnection? ❑X Yes El No <br /> ❑ Yes ❑No• ❑X NIA For tank systems that utilize the monitoring system as the primary tank overfill warning device(i.e.:no mechanical <br /> overfill prevention valve is installed),is the overfill warning alarm visible and audible at the tank fill points(s)and operating <br /> property? If so,at what percent of tank capacity does the alarm trigger? y, <br /> ❑ Yes' X❑No Was any monitoring equipment replaced?If yes,identify specific sensors,probes,or other equipment replaced and list the <br /> manufacturer name and model for all replacement parts in Section E,below. <br /> ❑ Yes• X❑No Was liquid found inside any secondary containment systems designed as dry systems?(check all that apply) ❑Product; <br /> ❑ Water. If yes,describe causes in Section E,below. <br /> ❑X Yes ❑No• Was monitoring system set-up reviewed to ensure proper settings?Attach set-up reports,if applicable. <br /> ❑X Yes ❑No• Is all monitoring equipment operational per manufacturers'specifications? <br /> •In Section E below,describe how and when these defrciences were or will be corrected. <br /> E. Comments: <br /> Page 2 of 3 Based on CA form dated 03/08 <br />